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Background Despite a lack of conclusive evidence of effect, methenamine hippurate is widely prescribed as preventive treatment for recurrent urinary tract infections (UTIs) in Norway. A national discontinuation of methenamine hippurate treatment due to a 4-month drug shortage in 2019 presented an opportunity to evaluate its preventive effect on UTIs among regular users. Objective To estimate the impact of the methenamine hippurate drug shortage on prescription frequency of UTI antibiotics. Methods Data from The Norwegian Prescription Database was analysed using an interrupted time series design. The time series consisted of 56 time periods of 14 days. The model included two naturally occurring interruptions: (i) the methenamine hippurate drug shortage, and (ii) reintroduction of the drug. The study population were 18 345 women ≥50 years receiving ≥2 prescriptions of methenamine hippurate in the study period before the shortage. Main outcome measure was number of prescriptions of UTI antibiotics per 1000 methenamine hippurate users. Prescription rates of antibiotics for respiratory tract infections were analysed to assess external events affecting antibiotic prescribing patterns. Results We found a significant increase of 2.41 prescriptions per 1000 methenamine hippurate users per 14-day period during the drug shortage (95%CI 1.39, 3.43, P  < 0.001), followed by a significant reduction of −2.64 prescriptions after reintroduction (95%CI −3.66, −1.63, P  < 0.001). Conclusions During the methenamine hippurate drug shortage, we found a significant increase in prescribing trend for UTI antibiotics followed by a significant decrease in prescribing trend after reintroduction. This change in trend seems to reflect a preventive effect of the drug on recurrent UTIs. [ABSTRACT FROM AUTHOR]

Objective: This scoping review investigates the status of research focusing on the nexus of community action, climate change, and health and wellbeing in anglophone Caribbean Small Island Developing States (SIDS). Methods: This review was guided by Arksey and O'Malley framework and utilized the PRISMA-ScR checklist. We searched Medline/OVID, PsychInfo, VHL, Sociological Abstracts, Google Scholar, and Scopus to capture interdisciplinary studies published from 1946 to 2021. Results: The search yielded 3,828 records of which fourteen studiesmet the eligibility criteria. The analysis assessed study aim, geographic focus, community stakeholders, community action, climate perspective, health impact, as well as dimensions including resources/assets, education/information, organization and governance, innovation and flexibility, and efficacy and agency. Nearly all studies were case studies using mixed method approaches involving qualitative and quantitative data. Community groups organized around focal areas related to fishing, farming, food security, conservation, and the environment. Conclusion: Despite the bearing these areas have on public health, few studies explicitly examine direct links between health and climate change. Research dedicated to the nexus of community action, climate change, and health in the anglophone Caribbean warrants further study. [ABSTRACT FROM AUTHOR]

Background The World Health Organization Model List of Essential Medicines (WHO EML) has played a critical role in guiding the country-level selection and financing of medicines for more than 4 decades. It continues to be a relevant evidence-based policy that can support universal health coverage (UHC) and access to essential medicines. The objective of this review was to identify factors affecting adaptation and implementation of WHO EML at the national level. Methods and findings We conducted a qualitative evidence synthesis by searching 10 databases (including CINAHL, Embase, Ovid MEDLINE, Scopus, and Web of Science) through October 2021. Primary qualitative studies focused on country-level implementation of WHO EML were included. The qualitative findings were populated in the Supporting the Use of Research Evidence (SURE) framework, and key themes were identified through an iterative process. We appraised the papers using the Critical Appraisal Skills Programme (CASP) tool and assessed our confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation working group-Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual). We screened 1,567 unique citations, reviewed 183 full texts, and included 23 studies, from 30 settings. Non-English studies and experiences and perceptions of stakeholders published in gray literature were not collected. Our findings centered around 3 main ideas pertaining to national adaptation and implementation of WHO EML: (1) the importance of designing institutions, governance, and leadership for national medicines lists (NMLs), particularly the consideration of transparency, coordination capacity, legislative mechanisms, managing regional differences, and clinical guidance; (2) the capacity to manage evidence to inform NML updates, including processes for contextualizing global evidence, utilizing local data and expert knowledge, and assessing budget impact, to which locally relevant cost-effectiveness information plays an important role; and (3) the influence of NML on purchasing and prescribing by altering provider incentives, through linkages to systems for financing and procurement and donor influence. Conclusions This qualitative evidence synthesis underscores the complexity and interdependencies inherent to implementation of WHO EML. To maximize the value of NMLs, greater investments should be made in processes and institutions that are needed to support various stages of the implementation pathway from global norms to adjusting prescribed behavior. Moreover, further research on linkages between NMLs, procurement, and the availability of medicines will provide additional insight into optimal NML implementation. Protocol registry PROSPERO CRD42018104112, Author(s): Elizabeth F. Peacocke 1,*, Sonja L. Myhre 1, Hakan Safaralilo Foss 2, Unni Gopinathan 1 Introduction The World Health Organization Model List of Essential Medicines (WHO EML) offers a [...]

Community groups are taking initiatives to adapt to a changing climate. These organizations differ from businesses and governments by being non-profit, often informal, resource limited, and reliant on volunteer labor. How these organizations facilitate collective action is not well known, especially since they do not necessarily solve common pool resource governance, but rather improve common pool resources through collective action. In fact, at first glance, community groups seem to not have the means for solving collective action problems used routinely in industry and government, such as paying people for cooperation or punishing them for lack of it. This article investigates how community groups solve collective action problems though data gathered across 25 organizations in three sites – Sitka, Alaska, USA; Toco, Trinidad; and a global site of distributed citizen science organizations. We found that community groups used positive reinforcement methods common to industry and used little punishment. Groups also engaged in mechanisms for collective action, such as relying on altruistic contributions by few individuals, that generally are not considered commonplace in businesses and governments. We conclude by discussing implications from this study for collective action theory and for how policymakers might learn from community groups to address climate change. [ABSTRACT FROM AUTHOR]

In pursuit of universal health coverage, many low- and middle-income countries are reforming their health financing systems and introducing health insurance schemes. As part of these reforms, lawmakers in The Gambia enacted 'The National Health Insurance Bill, 2021'. The Act will establish a National Health Insurance Scheme (NHIS) that pays for the cost of healthcare services for its members. This study assessed Gambians' willingness to pay (WTP) for a NHIS. Using multistage sampling design with no replacement, head/co-head of households were presented with a hypothetical health insurance scheme from July to August 2020. Their WTP and factors influencing WTP were elicited using a contingent valuation method. Descriptive statistics were used to describe sample characteristics. Lopez-Feldman's modified ordered probit model and linear regression were applied to estimate respondents' WTP as well as identify factors that influence their WTP. More than 90% of the respondents—677 (94.4%) were willing to join and pay for the scheme. Half of these respondents—398 (58.8%) agreed to pay the first bid of US dollars (US$) 20.78 or Gambian dalasi (GMD) 1000. The average WTP was estimated at US$23.27 (GMD1119.82), whereas average maximum amount to pay was US$26.01 (GMD1251.16). Results of the two models together showed that gender, level of education and household income were statistically significant, with the latter showing negative influence on WTP. The study found that Gambians were largely receptive to the scheme and have stated their willingness to contribute. Our findings can inform policymakers in The Gambia and other sub-Saharan countries when establishing contribution rates and exemption criteria during social health insurance scheme implementation. [ABSTRACT FROM AUTHOR]

Author(s): Kevin Outterson 1,2,3,*, Unni Gopinathan 4,5, Charles Clift 2,3, Anthony D. So 6,7, Chantal M. Morel 3,8, John-Arne Røttingen 2,3,5,9,10 Summary Points The current business model for antibiotics is [...]

This comment reflects on an article by Oortwijn, Jansen, and Baltussen about the use and features of 'evidenceinformed deliberative processes' (EDPs) among health technology assessment (HTA) agencies around the world and the need for more guidance. First, we highlight procedural aspects that are relevant across key steps of EDP, focusing on conflict of interest, the different roles of stakeholders throughout a HTA and public justification of decisions. Second, we discuss new knowledge and models needed to maximize the value of deliberative processes at the expanding frontiers of HTA, paying special attention to when HTA is applied in primary care, employed for public health interventions, and is produced through international collaboration. [ABSTRACT FROM AUTHOR]

Background: Intersectoral collaboration is critical to the successful implementation of many public health interventions (PHIs). Little attention has been paid to whether and how processes at the stage of evaluation can promote intersectoral collaboration. The objective of this study was to examine European experiences and views on whether and how the evaluation of PHIs promote intersectoral collaboration. Methods: A qualitative study design was used. We conducted semi-structured interviews with 15 individuals centrally involved in the evaluation of PHIs in 6 European countries (Austria, Denmark, England, Germany, Norway, and Switzerland). Questions pertained to current processes for evaluating PHIs in the country and current and potential strategies for promoting intersectoral collaboration. Transcripts were analyzed using thematic analysis to identify key themes responding to our primary objective. Results: Experiences with promoting intersectoral collaboration through the evaluation of PHIs could be summarized in 4 themes: (1) Early involvement of non-health sectors in the evaluative process and inclusion of non-health benefits can promote intersectoral collaboration, but should be combined with greater influence of these sectors in shaping PHIs; (2) Harmonization of methodological approaches may enable comparison of results and facilitate intersectoral collaboration, but should not be an overriding goal; (3) Involvement in health impact assessments (HIAs) can promote intersectoral collaboration, but needs to be incentivized and be conducted without putting overwhelming demands on non-health sectors; (4) A designated body for evaluating PHIs may promote intersectoral collaboration, but its design needs to take account of realities of policy-making. Conclusion: The full potential for promoting intersectoral collaboration through the evaluation of PHIs appears currently unrealized in the settings we studied. To further promote intersectoral collaboration, evaluators and decisionmakers may consider the full range of strategies characterized in this study. This may be most effective if the strategies are deployed so that they reinforce each other, value outcomes beyond health, and are tailored to maximize political priority for PHIs across sectors. [ABSTRACT FROM AUTHOR]